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International Centre for Disability and Rehabilitation

International Clinical Internship Handbook

2014

Disclaimer: The information provided in this handbook is of a general nature only and is not intended or designed to provide specific advice to the user. It is the responsibility of the user to independently seek advice and confirm the information relevant to their specific situation.

Table of Contents

Introduction

Section 1: Pre-departure Planning

Attributes for Overseas Effectiveness

Mental Preparedness

Travel Documents

Immunization Records/Vaccinations

Health

Packing

Section 2: In-Country Adaptation

Precautions to Take While Travelling

Cultural Adaptation

Culture Shock

Homesickness

Living Expenses

Common Travel-Related Diseases

First Aid/Health Kit

Health Insurance

Travel Insurance

Money Access

Clothing

Food

Entertainment

Transportation

Communication

Additional Tips

Section 3: Re-entry

Sources to Reference

Introduction

Deciding to go overseas to work, study or volunteer is no small undertaking. Through investing time in research and planning, you can significantly cut down on in-country stress. In recognition of the importance of cross-cultural preparedness, this handbook has been produced for University of Toronto Rehabilitation Sciences’ students who are planning to do a placement in another country. This information is intended to complement the country-specific handbook that each student will also receive.

This guide is a work in progress. As such, we welcome your evaluation of its usefulness as a tool and encourage suggestions regarding what information would benefit future students.This guide is for general information purposes only and it is the responsibility of the reader to seek independent professional advice for all aspects of their travel (e.g. health, safety, immigration) prior to embarking on their international placement.

ICDR History

Founded in 2004, the International Centre for Disability and Rehabilitation (ICDR) is a centre in the Rehabilitation Science Sector at the University of Toronto, and is committed to advancing research and education in the rehabilitation sciences to improve the lives of people with disabilities worldwide.We achieve our mission through authentic long-term partnerships with colleagues and organizations in resource-poor settings. Our education, research and service activities strive to address the priority health concerns of the communities with whom we partner.

ICDR has a strong history of sending University of Toronto students studying in the Occupational Therapy, Physical Therapy, and Speech Language Pathology sectors to a variety of countries around the world. Since 2004, ICDR has sent over 120 students to placements in West Africa, East Africa, China, India, Israel, UK, Scotland, the West Indies, and the US.

Section 1: Pre-departure Planning

Attributes for Overseas Effectiveness

When deciding whether you would make a good candidate for going overseas, consider whether you are flexible, adaptable and able to cope with change or processes that do not go as expected. It is essential that you are willing to learn and that you are aware of your own biases. Knowing ahead of time which situations might stress you will allow you to prepare.

Itis important that you have an understanding of the complexity of global health issues and recognize the interacting factors that affect health, particularly in low and middle-income resource settings. In fact, a Joint US/Canadian Committee on Global Health Care recommends that you should have competencies in 6 major areas:

1.Global burden of disease – have a basic understanding of the global causes of morbidity and mortality, as well as how gender and income influence health.

2.Health implicationsof travel, migration and displacement

3.Social and economic determinants of health – have a basic understanding of the economy and social norms and values in the country you are traveling to and how these impact health and the delivery of healthcare

4.Globalization of health and healthcare – understand that the quality of healthcare in these countries is the result of global trends in healthcare practice, commerce and culture

5.Healthcare in low-resource settings – determine barriers to healthcare in low and middle-income resource settings to better prepare you for workingwith clients/patients in these countries

6.Human rights in global health – make sure to reflect on the need for services in the country you are travelling to – recognize that support and services should be grounded in the belief that healthcare delivery is a human right as opposed to something that comes out of charity or sympathy

Also, there are nine values and principles of global health that will prepare and help you develop the necessary skills while you are abroad.[1] These include:

  1. Social justice - fair and impartial access to the benefits of society including the right to health
  2. Sustainability- living and working within the limits of available physical, natural and social resources in ways that allow living systems to thrive in perpetuity
  3. Reciprocity - multidirectional sharing and exchange of experience and knowledge among collaborating partners
  4. Respect - for the history, context, values and cultures of communities with whom we engage
  5. Honesty and openness - in planning and implementation of all collaborations
  6. Humility - in recognizing our own values, biases, limitations and abilities
  7. Responsiveness and accountability- to students and faculty and diverse communities with whom we are involved
  8. Equity - promoting the just distribution of resources and access, especially with respect to marginalized and vulnerable groups
  9. Solidarity – ensuring that objectives are aligned with those of the communities with which we are working

Mental Preparedness

It is normal to feel intimidated or nervous about entering a country or culture that is significantly different than that of your own. Talk to others who have visited your destination and ask them questions to help alleviate worries. Some areas that you will want to research include local attitudes towards:

  • Religion
  • Dress
  • Drugs
  • Alcohol consumption
  • Public displays of affection
  • Gender roles/inequalities

Furthermore, research information on:

  • Cultural values, rituals, and traditions
  • Weather
  • Geography
  • History
  • Language
  • Food
  • Medical facilities
  • Relations with Canada
  • Working conditions
  • Cost of living
  • Political system

A great deal of this information can be found on the Lonely Planet websiteor other travel guides, so consider purchasing one of these. It may also be useful to start a journal before leaving to identify where your worries lie. Remember, when you’ve done your homework you’ll be ready to enter this next adventure.

Travel Documents

Passport

If you do not already have a passport, apply for one as soon as possible since many countries request that your passport be valid for at least three months prior to your visa application, or for several months after your planned departure date. It is recommended that you apply for a new passport if your current passport expires in less than one year. This will help government officials feel more assured about your departure from their country. Applications may be obtained at the post office, applied for by mail or throughpassport offices located in larger cities.

Visa

You may have to obtain a visa for entry into the country you wish to go to prior to departure. You can determine if a visa is required by checking with that country’s immigration department and/or by contacting that country’s embassy in Canada. You will also need to confirm what type of visa to apply for and what supporting information will need to be submitted (e.g. some countries require letters of invitation from a local organization). Give yourself ample time as some embassies have slow processing times.

If you are planning on travelling to surrounding countries, ensure you apply for a Multiple Entry visa, which costs more than a Single Entry visa.

Immunization Records/Vaccinations

Many countries will expect you to show proof that you have received the required vaccinations to enter the country. For example, in yellow fever-affected countries, you will be required to show proof of vaccination upon arrival to be allowed entry into the country. You may also be required to show proof of yellow fever vaccination if travelling to a second country after being in a country with a risk of yellow fever.

Visiting a travel clinic is your best bet – your family doctor is probably not familiar with your specific needs as a long-term traveller facing a whole new world of tropical diseases. To locate a travel clinic nearest you, the Government of Canada recommends using the Public Health Agency of Canada’s list of designated yellow fever vaccination centres. Also, the University of Toronto Health Service offers travel medical appointments for academic-related travel at a reduced rate of $20 with a note from your departmental clinical coordinator. The sooner you can get an appointment, the better. A number of vaccinations require a series of shots that may have to be given up to a month apart.

Health

Before leaving you should:

  • Have an annual check-up. Get your doctor to write you a note explaining why you need any prescription medications you’ll be carrying.
  • Obtain the necessary vaccinations you need and whether you’ll need extra doses in country.
  • Ensure you have the necessary health/travel insurance.
  • Get prescriptions and extra medications for any ongoing illness.
  • Get a second set of glasses/contact lenses and bring along copy of you prescription.

Packing

For the sake of mobility, pack as light as possible! Little things add up in weight and size. Remember that although you may be isolated at some points, most of what you need is available in cities. Be sure to check the weight restrictions on your flight tickets! Try to leave extra room in your pack - you’ll probably have more to bring back on your way home. Small stuff-sacks, pouches, and organizers help if you are constantly living out of a bag. It makes it easier to repeatedly pack and unpack.

Checklist

Visa

Passport

Health and/or Travel Insurance

Ticket

Local currency

Access to funds for living expenses

Spare passport size photos

Photocopy of all important documents (visa, passport, insurance etc.)

If you have a smartphone consider taking photos of your documents

Important telephone numbers (i.e. Canadian embassy, local police, etc.)

Vaccinations and medications

Guidebook

Section 2: In-Country Adaptation

Prior to your departure, it is recommended that you review the Government of Canada’s Country Travel Advicefor official information regarding country-specific issues and situations that may affect your safety and well-being during your placement.

Precautions to Take While Travelling

Safety in Your Accommodation

  • Make sure you lock the door at all times.
  • While you are out, ensure that you hide valuables and/or money in a safe place.
  • If you plan on staying out late, make sure you let someone know when you‘ll be back
  • Always read the fire safety instructions in your accommodation and look for where the nearest fire and alternate exits are located.

Safety on the Street

  • Be especially careful when travelling in crowded areas (e.g., market places, train stations, etc.).
  • Avoid using narrow alleys, short cuts and poorly lit streets.
  • Do not disclose your travel plans to strangers.
  • Beware of pickpockets and scam artists. Always keep your belongings close at hand, and be wary of strangers who approach you.
  • Always try to ask for directions only from individuals in authority.
  • Make a list of emergency telephone numbers you may need during your stay. These include: police, fire, your accommodation number, and the Canadian embassy or consulate
  • Try to learn a few key phrases in the local language or have them in writing so that you can signal for police or medical help, if the situation arises.

Safety on Public Transportation

  • Always ride licensed taxis that have clear official markings. Avoid unmarked taxis.
  • Always have your belongings close at hand when riding crowded trains or buses. Consider making a wire cable lock to lock your pack/bag on long bus rides. Keep items like MP3 players, wallets, and cell phones out of view.
  • Try to plan your trips in advance. If you are taking a train or the bus, know which stop you have to get off at.
  • Do not travel alone at night.
  • Be sure to bring extra money in case you get lost or stranded or need to take another taxi, train or bus.

Handling Your Money Safely

  • Avoid carrying large amounts of cash.
  • Do not flash large amounts of cash when paying for items.
  • After every transaction, ensure that your credit card is returned to you.
  • When exchanging your money, deal only with authorized agents.
  • Report lost or stolen items immediately to the local police. Make a copy of the police report for insurance claims.
  • After making a police report, report the loss or theft of:
  • Credit cards to your credit card company
  • Airline tickets to the airline or travel agent
  • Passport to the Canadian embassy or consulate

Emergency Assistance in Canada

The University of Toronto Safety Abroad Office provides various services and resources to support students in placements outside of Canada, including emergency assistance. To access this service, you are required to register through theonline database.

In addition, the Foreign Affairs, Trade and Development Canada offers a free online service called “Registration of Canadians Abroad” that will keep you connected to Canada in case of an emergency.

Cultural Adaptation

Cultural adaption to a new country often requires one to see themselves as a “learner.” This approach gives you a chance to take a step back, learn from others’ behaviour, ask questions and be open to new ways of working with others. Cultural adaption is an on-going process versus something to be completed, so be patient. Often without being aware of it, cultural differences can lead to varying assumptions, behaviours and ways of dealing with conflict. The following outlines some of the most important factors to consider in the workplace.

  • Intercultural communication- Westerners tend to be more direct than many other cultures. Often people will talk about sensitive issues “under the surface.” Speaking directly about something can be considered rude. This may be frustrating for Westerners in the workplace so ask colleagues in private for clarification.
  • Cultural sensitivity - some topics can be sensitive and not appropriate to discuss in the workplace in certain countries. Examples include religion, money, gender roles and politics.
  • Cultural norms in the workplace – differing amounts of structure, different work ethic and communication styles can often frustrate Westerners in the workplace. Be open-minded and realize that everyone works differently. Discuss with your supervisor his/her expectations of you so you are not confused.
  • Gender roles - in many other countries these roles can be very different then in the West and you will need to consider if and when to speak up.

Culture Shock

Culture shock involves your reaction to unfamiliar or new surroundings. Each person reacts differently but it is not unusual to feel an inability to cope with your new circumstances. Culture shock can initially encompass feelings of extreme positivity to a location, with these feelings tempered over time. Waves of emotions as the mind and body adapt is all part of culture shock.Realizing that you are a minority and that your racial identity matters in your host country is a major contributing factor in experiencing culture shock. You are likely to be subject to increased attention and may be stereotyped for being wealthy or privileged,among other issues. While you will likely be given wonderful hospitality at some points, you may also face inflated prices at markets or people constantly staring at you. Exposure to these situations can bring on feelings of powerlessness, exhaustion, defensiveness, guilt, anger or confusion. These are natural reactions but there are various coping strategies.

Coping Strategies:

  • Find others to confide in
  • Be realistic about your expectations for what you want to accomplish and how you will integrate in the new culture
  • Exercise
  • Learn to laugh at yourself
  • Try new things and try to find something positive in each experience
  • Find a quiet place to think or write.

Use the acronym BE CEWL (Be cool):

Be realistic about your expectations

Exercise

Confide in others

Engage in something positive

Write about your experience

Laugh at yourself

Homesickness

Although you’ll be prepared and excited for your placement, it is inevitable that you will miss home, and experience feelings of homesickness. To tackle these feelings, you must realize that you are bound to feel homesick during your trip. Be prepared to pack items that remind you of home; like pictures of loved ones, books, music, etc. Always try to stay in touch with family and friends on a regular basis. Skype or other such programs can be a great comfort when feeling homesick. To combat feelings of loneliness, build friendships with other students. If you are feeling homesick, talk to them about it – they are probably going through the same thing too.

Always think positive. It might be helpful to list all the rewarding new experiences you are having during your placement as a reference whenever you are feeling homesick. Write down how these are helping you grow personally and professionally.

Living Expenses

Living expenses will vary considerably depending on the country you are visiting. When products are inexpensive there is often a temptation to buy many things. Be conscious of the weight and size and whether you can fit these items in your luggage for the flight home. If you decide you must buy certain things in some countries it can be inexpensive to send things by ship, as opposed to taking it back on the plane with you. Look into these alternatives if there are things you feel you can’t live without.

Common Travel-Related Diseases

Mosquito-Borne Diseases